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14 Cards in this Set
- Front
- Back
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what are the articular features of RA?
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1. inflammatory synovitis (palpable synovial swelling, worse in the am for >1hour)
2. symmetrical 3. polyarticular (>3 joins) 4. often involves: writst, MCP, PIP 5. often spares: thoracolumbar spine, DIPs of fingers and IPs of toes |
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what MHC II is associated with RA?
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HLA-DR4
-DRB1*0401 -DRB1*0404 "shared epitope" |
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what are extra articular features of RA?
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1. dry eyes and mouth (sicca) and eye disease (scleritis)
2. compression neuropathy 3. lung fibrosis, pleurisy 4. cardiac problems, artheroma, hyperlipidemia, HTN 5. kidney problems (NSAIDs, amyloid) 6. osteoporosis 7. leg ulcers, vasculitis 8. anaemia (felty's syndrome, chronic dz, Fe++ deficiency) |
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what are the criteria for classification of acute RA?
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4/7 of the following:
1. morning stiffness at least 1hr 2. soft-tissue swelling in at least 3 joints simultaneously 3. at least one area swollen in wrist, MCP< PIP 4. symmetric arthritis 5. rheumatoid nodules 6. abnormal serum RF 7. erosion or bony decalcification on hand/wrist x-ray *1-4 must be present for at least 6 weeks 6. |
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What are the 4 classes of ACR status as per HAQ:
1 2 3 4 |
Class 1: can perform ADL (self-care, vocational, avocational)
Class 2: self care yes, limited avocational Class 3: self care yes, limited vocational and avocational Class 4: all are limited |
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what needs to be assessed to determine treatment plan?
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1. current activity (am stiffness, synovitis, ESR)
2. degree of damage (ROM, deformities, x-ray joint space narrowing, functional status 3. extra-articular manifestations 4. prior Rx response and side effects |
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what are the elements necessary to devise a treatment plan?
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1. education (assisting devises, ACR, build relationship)
2. excercise (ROM, strength and conditioning) 3. medications (NSAIDs, DMARDS etc. and balance of safety with efficacy) |
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what are the classes are RA tx?
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1 NSAIDs
2 Traditional DMARDs 3 Immunosuppressants, including MTX 4 Tumor necrosis factor (TNF) inhibitors 5 Newer biologics |
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name 4 DMARDS:
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1. minocycline
2. sulfasalazine, hydroxychloroquine 3. im gold |
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what are immunosuppressors:
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1. MTX (most effective, good benefi: risk)
2. leflunomide |
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what needs to monitored in DMARD use?
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blood
liver lung kidney *every 2-6 months |
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name 3 TNF inhibitors:
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1. infliximab
2. enterocept 3. adalimumab |
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name and give the M/O of newer biologics?
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1. Rituximab: B-cell depletion (binds CD20)
2. Abatacept: inhibition of costimulatory molecules (binds CD80/86) |
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what are non-drug Rx in RA?4
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1. physiotherapy
2. OT 3. Rx shoes and orthotics 5. education info, coping skills |
